Senior Manager, Managed Care Contracting

📋 Description

• • Local Infusion LLC is embarking on a significant growth phase within the dynamic infusion space, and we are seeking a highly skilled and strategic Senior Manager, Managed Care Contracting to spearhead this crucial initiative. This is a pivotal new role designed to shape the vision and drive the execution of our payer strategy, contributing directly to the company's expansion and success.
• • Reporting to the Executive Director of Managed Care Partnerships, you will be instrumental in developing and implementing end-to-end managed care contracting processes. Your primary focus will be on driving payer contracting growth, expanding our network reach, and successfully re-negotiating existing agreements with a diverse range of payers, including local, regional, national, and government entities.
• • This role demands a proactive and collaborative approach, requiring you to engage directly with finance, field leaders, and other key internal stakeholders. You will be responsible for negotiating critical payment rates, structures, and contract terms that ensure the financial viability and strategic alignment of our infusion services.
• • A core aspect of your responsibility will be to cultivate and nurture strong relationships with our health plan partners. This involves effectively communicating the unique value proposition of Local Infusion, highlighting our commitment to quality patient care, operational excellence, and positive patient outcomes. You will act as a key liaison, ensuring our partners understand the benefits of collaborating with us.
• • You will be adept at translating complex information into clear, concise communications, tailored for both technical and non-technical audiences. This skill is essential for building and maintaining robust relationships with a wide array of stakeholders, including health plans, Accountable Care Organizations (ACOs), hospital systems, and various provider networks.
• • Beyond contract negotiation, your purview will extend to overseeing critical operational aspects that impact revenue and patient satisfaction. This includes diligently monitoring claims processing, managing appeals effectively, and overseeing utilization management processes. Your vigilance in these areas will be crucial in preventing revenue leakage and ensuring the timely and efficient resolution of all related matters.
• • Facilitating seamless communication with our providers and affiliates is paramount. You will ensure that all key contract information, encompassing operational terms, legal requirements, and reimbursement rates, is disseminated effectively to our operational and revenue cycle teams. This ensures consistent application of contract terms across the organization.
• • As Local Infusion continues to grow through acquisitions and new partnerships, you will play a vital role in coordinating the alignment and integration of our managed care contracting efforts. Your objective will be to ensure a smooth and efficient transition, seamlessly integrating new entities and partnerships into our existing contracting framework while upholding Local Infusion’s strategic objectives.
• • You will be expected to stay ahead of the curve regarding changes in regulatory requirements that impact managed care contracting and healthcare operations. This proactive approach will involve leading efforts to understand these shifts and ensuring timely adjustments to our strategies and compliance protocols, safeguarding the organization against potential risks.
• • This role offers a unique opportunity to shape the future of managed care contracting at Local Infusion. You will be empowered to develop innovative strategies, build lasting partnerships, and contribute significantly to the company's mission of providing exceptional infusion services. Your expertise will directly influence our ability to expand access to care and enhance patient outcomes across our service areas.
• • The Senior Manager will be a key player in strategic planning sessions, providing insights and data-driven recommendations to senior leadership regarding payer strategy, market trends, and potential growth opportunities. Your analytical skills will be leveraged to assess contract performance, identify areas for improvement, and develop proposals for new contracting initiatives.
• • You will also be responsible for developing and maintaining a comprehensive understanding of the competitive landscape, identifying best practices in managed care contracting, and adapting them to Local Infusion’s unique operational model. This includes staying informed about emerging reimbursement models and value-based care initiatives that could benefit the organization and its patients.
• • Ultimately, this role is about driving sustainable growth through strategic payer relationships and robust contract management, ensuring Local Infusion remains a leader in the infusion therapy sector.